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HYPERADRENOCORTICISM IN DOGS (CLINICAL SIGNS :question: (Abdominal…
HYPERADRENOCORTICISM IN DOGS
WHAT
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Also known as Cushing's disease or pituitary-dependent hyperadrenocorticism, arises from adenomatous enlargement of the pitutary gland, resulting in excessive ACTH production.
TYPES
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Pituitary gland tumor
:red_flag:The tumor causes the pituitary gland to overproduce a hormone (ACTH) that stimulates the adrenal glands to produce cortisol.
:red_flag:Benign growths of the pituitary are called macroadenomas and are typically larger than 1 cm diameter.
Adrenal gland tumor
:red_flag:May be the result of a benign or malignant tumor of the adrenal gland.
:red_flag:If the tumor is benign, surgical removal will cure the disease.
:red_flag:If the tumor is malignant, surgery may help for some time, but the prognosis is much less favorable.
Excessive cortisol from prolonged use of steroids
:red_flag:Is called iatrogenic Cushing's disease.
:red_flag:It is caused when there is excessive administration of an oral or injectable steroid.
AETIOLOGY
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Common cause of hyperadrenocorticism in dogs is a benign (non-spreading) pituitary tumor.
Rarely, pituitary tumors may be malignant.
CLINICAL SIGNS
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Abdominal enlargement ("pot-belly")
Recurrent urinary tract infections
Heat intolerance
Polydipsia
Polyphagia (extreme hunger)
Polyuria
Muscle weakness, lethargy
Alopecia
Cutaneous hyperpigmentation
Phlebectasias (abnormal fusiform dilatation of a vein)
Calcinosis cutis (calcium deposits form in the skin)
Pyoderma (bacterial skin infection that contain pus)
DIAGNOSIS
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Low-dose dexamethasone suppression test (LDDS)
:pencil2:LDDS test is the screening test of choice for canine hyperadrenocorticism.
:pencil2:Dogs with hyperadrenocorticism exhibit suppressed cortisol concentration at 3-4 hours and sometimes it is takes time to 8 hours.
Urine cortisol to creatinine ratio (UCCR)
:pencil2: Is a highly sensitive test to differentiate healthy dogs from those with hyperadrenocorticism, but it is not highly specific because dogs with moderate to severe nonadrenal illness also exhibit increased ratios.
:pencil2:UCCR should be determined based on free-catch urine collected at home by owner to prevent the stress of animal that will cause falsely increased UCCR.
:pencil2:An increased UCCR should be confirmed with an LDDS test.
ACTH stimulation test
:pencil2:Used to diagnose various adrenopathic disorders, including endogenous or iatrogenic hyperadrenocorticism and spontaneous hyperadrenocorticism.
TREATMENT
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Adrenolytic agent mitotane
:pen:Beginning with an induction dosage of 25-50 mg/kg/day for 7-10 days.
:pen:Water consumption or appetite may be measured to provide an endpoint for the therapy, water consumption should decrease to <60 mL/kg/day.
:pen:To maintain suppression of cortisol secretion, mitotane is administered at a dosage of 50 mg/kg per week.
Adrenal enzyme inhibitor trilostane
:pen:Trilostane is an effective steroid inhibitor with minimal adverse effects.
:pen:Should be administered twice daily at a starting dose of 1-3 mg/kg PO to achieve s decrease in glucocorticoid secretion from the adrenal glands.
Surgical
:pen:Surgical removal of unilateral adenomas or adenocarcinomas may be indicated in some cases.
NUR DIYANA BINTI MOHD RUSUKI (D17A0024)
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